ne of the most exciting and significant advances in reproductive medicine in the past decade has been the advent of egg donation , a type of in vitro fertilization that allows the eggs of one woman to be given to another. The process gives women with previously poor or even hopeless fertility prognoses an excellent chance to become pregnant and subsequently deliver a healthy baby.

The most common reason for egg donation is age factor infertility. A woman’s egg supply is fixed before birth and every day a number of eggs are lost. Ultimately the egg supply reaches zero and menopause occurs, typically at age 51 (plus or minus 12 years). Long before menopause the egg supply and quality of remaining eggs decreases to such a level that pregnancy becomes unlikely. Thus women experience significantly reduced fertility 10-15 years before menopause. This is not a well known fact and hence many women have planned their lives and careers based on the mistaken belief that their fertility will remain normal well into their forties.

As a result a majority of women seeking egg donation are in their forties and have found their egg supply to be too low to allow a reasonable chance of pregnancy. Others, in their thirties and occasionally even their twenties, have run out of eggs much earlier than usual. Sometimes this is in the form of premature menopause (or premature ovarian failure) while in others they continue to have periods but nonetheless have extremely low egg supplies. Still others may have had their ovaries surgically removed (ovarian tumors of various kinds) or were born without functional ovaries (gonadal dysgenesis or Turner’s syndrome).

Fortunately egg donation is very effective, producing the highest success rate of all infertility treatments. In cases where the recipient’s uterus is found to be normal (by pelvic exam and ultrasound) and the egg donor is less than 34 years old, the medical group we work with (California North Bay Fertility Medical Associates) has been able to maintain a viable pregnancy rate of nearly 60% per treatment cycle. In addition over one half of recipient couples will have enough good quality extra embryos to freeze for another attempt later on.

Potential donors undergo medical and psychological screening tests to be sure they are satisfactory from the general health, hormonal and psychological perspectives. The medical tests include a careful medical history, a pelvic examination (including a pelvic ultrasound), blood tests to look for infectious diseases (HIV, hepatitis B, hepatitis C, syphilis and HTLV-I), cervical cultures for gonorrhea and chlamydia and hormone blood tests to predict ovarian response to the fertility drugs we use. The psychological screening includes an interview with a therapist experienced in this area.

As for the actual process of egg donation, it is best to think of it as an in vitro fertilization (IVF) cycle split between two women. Both women take birth control pills for a few weeks and then receive a shot of Depo-Lupron. This serves to synchronize the menstrual cycles of the women and get both of them to the "starting gate" at the same time. The recipient then begins receiving estrogen in the form of an estradiol valerate injection twice a week. This estradiol is the same main estrogen normally produced by the ovaries.

Meanwhile the donor receives daily injections of fertility drugs (such as Follistim, Gonal-F, Fertinex, Repronex, Humegon, HMG or Pergonal) which helps mature a group of eggs in her ovaries. Usually 7-12 days of fertility drugs are required before the eggs are mature. Soon after this point the recipient begins progesterone, the only other hormone necessary to maintain pregnancy. This is in the form of oral capsules, vaginal cream (Crinone) and/or a daily injection. It has long been our custom to teach a spouse, relative, friend or neighbor to give injections so frequent trips to our office are not needed.

The eggs are gathered at the "egg retrieval" which is a procedure done in the office under very light anesthesia (actually intravenous sedation). An anesthesiologist administers the medications and a physician then uses a needle guided by ultrasound to retrieve the eggs. The needle passes through the top wall of the vagina and directly into the fluid filled egg sacs ("follicles"). This sounds complex but is actually quite easy and causes no pain, thanks to the anesthesia. It takes about 15 minutes to gather the eggs and the donor is ready to go home 60-90 minutes later.

The eggs are usually inseminated a few hours after retrieval with sperm from the recipient’s husband. This is done by the embryologists who are also responsible for culturing the fertilized eggs (now called embryos) until the time of transfer to the recipient’s uterus. The embryo transfer is usually done 3 days after the egg retrieval when the embryos are at the 4-10 cell stage. This is a very simple procedure and is nearly always completely painless. It is very much like a routine pelvic exam and involves the passage of a very small plastic catheter through the recipient’s cervix. A tiny drop (20-30 microliters) of culture media with the microscopic embryos suspended within is deposited in the upper reaches of the uterus. Good quality embryos that are not transferred can be frozen for a later transfer (in a few months if the first transfer is not successful or several years later if it is).

The risks a donor encounters during the egg donation process are mainly those of anesthesia complication, infection and excessive ovarian response ("hyperstimulation") to the fertility drugs. The chance of a terrible complication from the anesthesia, such as stroke, aspiration or death, has been calculated to be approximately 1 in 20,000. The risk of an infection following the egg retrieval has been reported to be 1 per 1,000 in the medical literature. The risk of hyperstimulation, where the ovaries become enlarged and painful, is one per hundred (1%).

Egg donors must also consider a potential risk: can fertility drugs given to young women cause problems later on in life, such as an increased risk of breast or ovarian cancer? To date there is no indication of problems for donors but the period of observation has been relatively short (since 1989). A multi-center study sponsored by the National Institutes of Health is underway to address this question specifically and thus far the results are reassuring. However we won’t be able to say for sure that there are absolutely no long term health risks for quite some time.

For the recipient the main risk of egg donation is that of pregnancy itself. While medical complications and even maternal death are more common in women over age 40, the results with egg donation have been very good so far. This is undoubtedly because of the careful medical screening done before women are allowed to proceed with the egg donor process. The message is that pregnancy can be safely undertaken up until age 55 (and possibly older) if a woman’s health is excellent.

A special risk of egg donation is that of too much success (multiple pregnancy). Before the power of this process was understood large multiple pregnancies (triplets, quadruplets and even quintuplets) were not unusual. Now only a small number (2 or 3) of the most healthy embryos are transferred. The high success rate has been maintained and the really large multiples (quadruplets, quintuplets) have been eliminated. Triplets have been reduced to a very low level, leaving only twins as a continued problem. All in all, about 35% of egg donation pregnancies are twins.

Because the eggs come from another person there is a theoretical risk of the transmission of disease, such as hepatitis or AIDS, to the recipient. As the donors are pre-screened for infectious diseases this has never been reported to have happened.

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